42 U.S.C. 1395i-3: Requirements for, and assuring quality of care in, skilled nursing facilities

2021

• Pub. L. 117–2 added subsec. (k). (American Rescue Plan Act of 2021) Law text · (k)

2014

• Pub. L. 113–185 added par. (3). (Improving Medicare Post-Acute Care Transformation Act of 2014" or the "IMPACT Act of 2014) Law text · (i)

2010

• Pub. L. 111–148, §6121(a)(2), inserted concluding provisions. (Patient Protection and Affordable Care Act) Law text · (b)
• Pub. L. 111–148, §6101(c)(1)(A), redesignated subpar. (C) as (B) and struck out former subpar. (B) which related to required notice to a State licensing agency of change in ownership, control interest, management, or certain positions of responsibility for a skilled nursing facil… (Patient Protection and Affordable Care Act) Law text · (d)
• Pub. L. 111–148, §6103(c)(1), added subpar. (C). Former subpar. (C) redesignated (B). (Patient Protection and Affordable Care Act) Law text · (d)
• Pub. L. 111–148, §6121(a)(1), inserted "(including, in the case of initial training and, if the Secretary determines appropriate, in the case of ongoing training, dementia management training, and patient abuse prevention training" after "curriculum". (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §6103(a)(3), added par. (8). (Patient Protection and Affordable Care Act) Law text · (f)
• Pub. L. 111–148, §6103(a)(2)(A), added subpar. (E). (Patient Protection and Affordable Care Act) Law text · (g)
• Pub. L. 111–148, §6111(a)(1), designated existing provisions as subcl. (I), inserted heading, substituted "Subject to subclause (II), the Secretary" for "The Secretary", and added subcls. (II) to (IV). (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §6113(b), substituted "the Secretary, subject to section 1320a–7(h) of this title, shall terminate" for "the Secretary shall terminate" and "subsection (c)(2) and section 1320a–7j(h) of this title" for "subsection (c)(2)". (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §6111(a)(2), inserted "(ii)(IV)," after "(i),". (Patient Protection and Affordable Care Act) Law text · (h)
• Pub. L. 111–148, §6103(a)(1), added subsec. (i) and redesignated former subsec. (i) as (j). (Patient Protection and Affordable Care Act) Law text · (i), (j)

2003

• Pub. L. 108–173, §736(a)(8)(A), substituted "at least" for "at least at least". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (b)
• Pub. L. 108–173, §736(a)(8)(B), substituted "physical, mental" for "physical mental". (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (d)
• Pub. L. 108–173, §932(c)(2)(A), substituted "subparagraphs (C) and (D)" for "subparagraph (C)" in introductory provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• Pub. L. 108–173, §736(a)(8)(C), realigned margins of concluding provisions. (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• Pub. L. 108–173, §932(c)(2)(B), added subpar. (D). (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) Law text · (f)
• 2000–Subsec. (b)(8). Pub. L. 106–554 added par. (8). (Consolidated Appropriations Act, 2001) Law text · (f)

1997

• Pub. L. 105–33, §4432(b)(5)(A), substituted "Subject to the timeframes prescribed by the Secretary under section 1395yy(e)(6) of this title, such" for "Such" in introductory provisions. (Balanced Budget Act of 1997) Law text · (b)
• Pub. L. 105–15, §1(1), inserted "subject to subparagraph (C)," after "(iii)". Law text · (f)
• Pub. L. 105–15, §1(2), added subpar. (C). Law text · (f)
• Pub. L. 105–33, §4755(a), added subpar. (D) and redesignated former subpar. (D) as (E). (Balanced Budget Act of 1997) Law text · (g), (E)

1994

• Pub. L. 103–432, §110(b), substituted "but no later than 14 days" for "but no later than not later than 14 days". · (b)
• Pub. L. 103–432, §106(d)(1), struck out comma before "or a new competency evaluation program". · (b)
• Pub. L. 103–432, §106(d)(2), substituted "licensed or certified social worker, registered respiratory therapist, or certified respiratory therapy technician" for "or licensed or certified social worker". · (b)
• Pub. L. 103–432, §106(c)(2)(A), inserted at end "In determining whether such a consultant is qualified to conduct reviews under the preceding sentence, the Secretary shall take into account the needs of nursing facilities under this subchapter to have access to the services of su… · (c)
• Pub. L. 103–432, §106(c)(3)(A), substituted "$100" for "$50". · (c)
• Pub. L. 103–432, §106(c)(4)(A), inserted ", but shall not include any allegations of resident abuse or neglect or misappropriation of resident property that are not specifically documented by the State under such subsection" after "individual disputing the findings" in first sent… · (e)
• Pub. L. 103–432, §106(d)(3), substituted "facilities (subject to clause (iii))," for "facilities,". · (f)
• Pub. L. 103–432, §106(c)(1)(A), inserted before semicolon at end ", unless the survey shows that the facility is in compliance with the requirements of subsections (b), (c), and (d) of this section". · (f)
• Pub. L. 103–432, §106(d)(4), substituted "clause" for "clauses" in two places. · (f)
• Pub. L. 103–432, §106(c)(4)(B), substituted second sentence for former second sentence which read as follows: "The State shall, after notice to the individual involved and a reasonable opportunity for a hearing for the individual to rebut allegations, make a finding as to the acc… · (g)
• Pub. L. 103–432, §106(d)(5), substituted "paragraph" for "paragraphs" before "(1), (2), or (4) of subsection (h)". · (g)

1992

• Pub. L. 102–375 substituted "title III or VII of the Older Americans Act of 1965 in accordance with section 712 of the Act" for "section 307(a)(12) of the Older Americans Act of 1965". · (c), (g)

1990

• Pub. L. 101–508, §4008(h)(2)(B), inserted at end "A State or the Secretary may not require disclosure of the records of such committee except insofar as such disclosure is related to the compliance of such committee with the requirements of this subparagraph." · (b)
• Pub. L. 101–508, §4008(h)(2)(C), substituted "not later than 14 days" for "4 days". · (b)
• Pub. L. 101–508, §4008(h)(2)(D), added cl. (vii). · (b)
• Pub. L. 101–508, §4008(h)(2)(E), added subcls. (IV) and (V). · (b), (V)
• Pub. L. 101–508, §4008(h)(1)(B), designated existing provisions as cl. (i), in introductory provisions substituted "Except as provided in clause (ii), a skilled nursing facility" for "A skilled nursing facility" and "on a full-time basis" for "(on a full-time, temporary, per diem… · (b)
• Pub. L. 101–508, §4008(h)(1)(C), substituted "any State registry established under subsection (e)(2)(A) that the facility believes will include information" for "the State registry established under subsection (e)(2)(A) as to information in the registry". · (b)
• Pub. L. 101–508, §4008(h)(1)(D), inserted before period at end ", or a new competency evaluation program" after "and competency evaluation program". · (b)
• Pub. L. 101–508, §4008(h)(2)(F), substituted "(G)) or a registered dietician," for "(G)),". · (b)
• Pub. L. 101–508, §4008(h)(2)(G)(B)[(ii)], inserted at end "A resident's exercise of a right to refuse transfer under clause (x) shall not affect the resident's eligibility or entitlement to benefits under this subchapter or to medical assistance under subchapter XIX of this chapt… · (c)
• Pub. L. 101–508, §4008(h)(2)(H), inserted before period at end "and to access to current clinical records of the resident upon request by the resident or the resident's legal representative, within 24 hours (excluding hours occurring during a weekend or holiday) after making … · (c)
• Pub. L. 101–508, §4008(h)(2)(G)(i), added cl. (x) and redesignated former cl. (x) as (xi). · (c), (xi)
• Pub. L. 101–508, §4008(h)(2)(I), inserted "including the notice (if any) of the State developed under section 1396r(e)(6) of this title" after "in such rights)". · (c)
• Pub. L. 101–508, §4206(d)(1), added subpar. (E). · (c)
• Pub. L. 101–508, §4008(h)(2)(J), substituted "subsection (f)(2)" for "clause (i) or (ii) of subsection (f)(2)(A)". · (e)
• Pub. L. 101–508, §4008(h)(2)(K)(i), inserted before period at end ", or any individual described in subsection (f)(2)(B)(ii) or in subparagraph (B), (C), or (D) of section 6901(b)(4) of the Omnibus Budget Reconciliation Act of 1989". · (e)
• Pub. L. 101–508, §4008(h)(2)(K)(ii), added subpar. (C). · (e)
• Pub. L. 101–508, §4008(m)(3)(F)[(E)], struck out "and" after semicolon at end. · (f)
• Pub. L. 101–508, §4008(h)(1)(E), struck out "and" at end of subcl. (I), inserted "who is employed by (or who has received an offer of employment from) a facility on the date on which the aide begins either such program" after "nurse aide" and substituted ", and" for period at… · (f)
• Pub. L. 101–508, §4008(h)(1)(G), inserted "(through subcontract or otherwise)" after "may not delegate" in second sentence. · (f)
• Pub. L. 101–508, §4008(h)(1)(F)(i), amended subcl. (I) generally. Prior to amendment, subcl. (I) read as follows: "offered by or in a skilled nursing facility which has been determined to be out of compliance with the requirements of subsection (b), (c), or (d) of this se… · (f)
• Pub. L. 101–508, §4008(h)(2)(L), inserted at end "A State shall not make a finding that an individual has neglected a resident if the individual demonstrates that such neglect was caused by factors beyond the control of the individual." · (g)
• Pub. L. 101–508, §4008(h)(2)(M), substituted "deficiencies, within 14 calendar days after such information is made available to those facilities, and approved plans" for "deficiencies and plans". · (g)
• Pub. L. 101–508, §4008(h)(2)(N), substituted "or of any adverse action taken against a skilled nursing facility under paragraphs (1), (2), or (4) of subsection (h), with respect" for "with respect". · (g)

1989

• Pub. L. 101–239, §6901(b)(1)(A), substituted "October 1, 1990" for "January 1, 1990" in introductory provisions. · (b)
• Pub. L. 101–239, §6901(b)(1)(B), substituted "January 1, 1990" and "October 1, 1990" for "July 1, 1989" and "January 1, 1990", respectively. · (b)
• Pub. L. 101–239, §6901(d)(4)(A), substituted "Secretary until such an order could reasonably be obtained)" for "Secretary) until such an order could reasonably be obtained". · (c)
• Pub. L. 101–239, §6901(d)(4)(B), substituted "accommodation" for "accommodations". · (c)
• Pub. L. 101–239, §6901(d)(4)(C), substituted "and content of the curriculum" for ", content of the curriculum". · (f)
• Pub. L. 101–239, §6901(b)(3)(A), inserted "care of cognitively impaired residents," after "social service needs,". · (f)
• Pub. L. 101–239, §6901(b)(3)(B), substituted "recognition of mental health and social service needs, care of cognitively impaired residents" for "cognitive, behavioral and social care". · (f)
• Pub. L. 101–239, §6901(b)(3)(C), (D), added cl. (iv). · (f)
• Pub. L. 101–239, §6901(d)(4)(D), inserted "after the effective date of the findings" after "6 months" in introductory provisions. · (h)

1988

• Pub. L. 100–360, §411(l)(2)(B), struck out "in the case of a resident eligible for benefits under subchapter XIX of this chapter," before "uses an instrument". · (b)
• Pub. L. 100–360, §411(l)(2)(A), as amended by Pub. L. 100–485, §608(d)(27)(C), struck out "in the case of a resident eligible for benefits under this part," before "includes the identification". · (b)
• Pub. L. 100–360, §411(l)(2)(C), amended subcl. (III) generally. Prior to amendment, subcl. (III) read as follows: "The Secretary shall provide for imposition of civil money penalties under this clause in a manner similar to that for the imposition of civil money penaltie… · (b)
• Pub. L. 100–360, §411(l)(1)(A)(i), substituted "than January 1, 1991" for "than October 1, 1990". · (b)
• Pub. L. 100–360, §411(l)(1)(A)(ii), substituted "24-hour licensed nursing" for "24-hour nursing", "must use" for "must employ", and "at least 8 consecutive hours a day," for "during the day tour of duty (of at least 8 hours a day)". · (b)
• Pub. L. 100–360, §411(l)(2)(D)(i), as amended by Pub. L. 100–485, §608(d)(27)(D), struck out ", who is not a licensed health professional (as defined in subparagraph (E))," after "any individual". · (b)
• Pub. L. 100–360, §411(l)(1)(A)(iii), substituted "January 1, 1990" for "October 1, 1989, (or January 1, 1990, in the case of an individual used by the facility as a nurse aide before July 1, 1989)". · (b)
• Pub. L. 100–360, §411(l)(2)(D)(ii), substituted "nursing or nursing-related services" for "such services". · (b)
• Pub. L. 100–360, §411(l)(2)(D)(iii), inserted "physical or occupational therapy assistant," after "occupational therapist,". · (b)
• Pub. L. 100–360, §411(l)(1)(A)(iv), as added by Pub. L. 100–485, §608(d)(27)(A), added subpar. (D). · (c)
• Pub. L. 100–360, §411(l)(2)(F), substituted "for a stay at the facility" for "an allowable charge imposed by the facility for an item or service requested by the resident and for which a charge may be imposed consistent with this subchapter and subchapter XIX of this chapter". · (c)
• Pub. L. 100–360, §411(l)(2)(G), substituted "upon the written" for "once the facility accepts the written" in subpar. (A)(ii), and "Upon written" for "Upon a facility's acceptance of written" in subpar. (B). · (c)
• Pub. L. 100–360, §411(l)(1)(A)(v), formerly §411(l)(1)(A)(iv), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "January" for "March". · (e)
• Pub. L. 100–360, §411(l)(1)(A)(vi), formerly §411(l)(1)(A)(v), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "January" for "March". · (e)
• Pub. L. 100–360, §411(l)(1)(A)(vii), formerly §411(l)(1)(A)(vi), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "January" for "March". · (e)
• Pub. L. 100–360, §411(l)(2)(H), inserted after first sentence "The State shall make available to the public information in the registry." · (e)
• Pub. L. 100–360, §411(l)(2)(I), inserted "and discharges" after "transfers" in heading and in two places in text. · (e)
• Pub. L. 100–360, §411(l)(1)(A)(viii), formerly §411(l)(1)(A)(vii), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "1989" for "1990". · (e)
• Pub. L. 100–360, §411(l)(1)(A)(ix), formerly §411(l)(1)(A)(viii), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "1990" for "1989" in introductory provisions. · (e)
• Pub. L. 100–360, §411(l)(2)(J), substituted "recognition of mental health and social service needs" for "cognitive, behavioral and social care". · (f)
• Pub. L. 100–360, §411(l)(2)(I), inserted "and discharges" after "transfers" in heading and in text. · (f)
• Pub. L. 100–360, §411(l)(1)(A)(x), formerly §411(l)(1)(A)(ix), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "1988" for "1989". · (f)
• Pub. L. 100–360, §411(l)(1)(A)(xi), formerly §411(l)(1)(A)(x), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "January" for "July". · (f)
• Pub. L. 100–360, §411(l)(1)(A)(xii), formerly §411(l)(1)(A)(xi), as redesignated by Pub. L. 100–485, §608(d)(27)(A), substituted "April" for "October". · (f)
• Pub. L. 100–360, §411(l)(2)(K), substituted "residents" for "patients". · (f)
• Pub. L. 100–360, §411(l)(2)(L)(i), substituted "shall include" for "shall not include". · (f)
• Pub. L. 100–360, §411(l)(5)(A)–(C), substituted "and timely review" for ", review,", inserted "or by another individual used by the facility in providing services to such a resident" after "a nursing facility", and substituted "The State shall, after notice to the individual invo… · (g)
• Pub. L. 100–360, §411(l)(5)(D), substituted "to issue regulations to carry out this subsection" for "to establish standards under subsection (f) of this section". · (g)
• Pub. L. 100–360, §411(l)(5)(E), amended third sentence generally. Prior to amendment, third sentence read as follows: "The Secretary shall provide for imposition of civil money penalties under this clause in a manner similar to that for the imposition of civil money penalties … · (g)
• Pub. L. 100–360, §411(l)(5)(F), as added by Pub. L. 100–485, §608(d)(27)(I), substituted "practicable" for "practical". · (g)
• Pub. L. 100–360, §411(l)(4), substituted "January" for "October". · (g)
• Pub. L. 100–360, §411(l)(5)(G), formerly §411(l)(5)(F), as redesignated by Pub. L. 100–485, §608(d)(27)(I), substituted "on the basis of that survey" for "on that basis". · (g)
• Pub. L. 100–360, §411(l)(5)(H), formerly §411(l)(5)(G), as redesignated by Pub. L. 100–485, §608(d)(27)(I), struck out "chronically" after "enforcement actions against" in last sentence. · (g)
• Pub. L. 100–360, §411(l)(7)(A), substituted ". The provisions of section 1320a–7a of this title (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under s… · (h)
• Pub. L. 100–360, §411(l)(11), as added by Pub. L. 100–485, §608(d)(27)(L), substituted "clauses (i), and (iii) of paragraph (2)(B)" for "clauses (i), (iii), and (iv) of paragraph (2)(A)". · (h)
• Pub. L. 100–360, §411(l)(7)(B), inserted "by such facilities" after "be made available". · (h)

1987

• Pub. L. 100–203, §§4202(a)(2), 4203(a)(2), 4206, added subsecs. (g), (h), and (i), respectively. · (g), (h), (i)